Effectiveness of vaginal microbicides in preventing HIV transmission

• Published in: Tropical medicine & international health 2020-07, Vol.25 (7), p.790-802
• Main Authors: Musekiwa, Alfred, Fernando, Nimasha B., Abariga, Samuel A.
• Format: Article
• Language: English
• Subjects: Bias; Buffers; Cellulose; dapivirinery; Disease transmission; Health risks; Heterogeneity; HIV; HIV prevention; Human immunodeficiency virus; Infections; Meta-analysis; Microbicides; Nonoxynol; Pregnancy; Risk analysis; Risk assessment; Risk management; Risk reduction; Sexually transmitted diseases; STD; Subgroups; Sulfates; systematic review; Tenofovir; Vagina; vaginal microbicide; vaginal ring
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13401

Objective To evaluate the evidence on the effectiveness of vaginal microbicides in preventing HIV transmission in women. Methods Systematic review through a comprehensive search of relevant electronic databases for eligible randomised controlled trials (RCTs) published through June 2019. Two authors independently screened titles and s according to eligibility criteria, then extracted data and assessed risk of bias of included studies. We conducted a random‐effects meta‐analysis of risk ratios (RR) of HIV infection and assessed heterogeneity using chi‐squared and I2 tests. Sources of heterogeneity were investigated through subgroup analysis, publication bias was assessed using funnel plots, and certainty of evidence was graded using GRADEPro software. Results We included 18 RCTs which enrolled 40,048 sexually active, HIV‐negative, non‐pregnant women, aged 16 years and older, mainly from sub‐Saharan Africa. The intravaginal ring containing dapivirine significantly reduced HIV risk by 29% (RR 0.71, 95% CI: 0.57–0.89; 2 RCTs, 4,564 women, moderate certainty of evidence). Estimates of effect of tenofovir 1% (RR 0.83, 95% CI: 0.65–1.06), nonoxynol‐9 (RR 1.15, 95% CI: 0.93–1.42), cellulose sulphate (RR 1.16, 95% CI: 0.61–2.21), SAVVY (RR 1.34, 95% CI: 0.69–2.59), Carraguard (RR 0.89, 95% CI: 0.71–1.10), BufferGel (RR 1.02, 95% CI: 0.71–1.46), 0.5% PRO2000 (RR 0.88, 95% CI: 0.60–1.28) and 2% PRO2000 (RR 0.81, 95% CI: 0.58–1.12) failed to reach statistical significance; each had low certainty of evidence. Conclusion The long‐acting intravaginal ring containing dapivirine significantly reduced risk of HIV transmission in women by 29%. The remaining microbicides had no evident effect. Objectif Evaluer les données probantes sur l'efficacité des microbicides vaginaux dans la prévention de la transmission du VIH chez les femmes. Méthodes Analyse systématique à travers une recherche exhaustive des bases de données électroniques pertinentes pour les essais contrôlés randomisés (ECR) éligibles publiés jusqu’en juin 2019. Deux auteurs ont indépendamment passé en revue les titres et résumés selon des critères d’éligibilité, les données ont alors été extraites et le risque de biais évalué pour des études incluses. Nous avons effectué une méta‐analyse des effets aléatoires des rapports de risque (RR) de l'infection par le VIH et évalué l'hétérogénéité à l'aide des tests Chi2 et I2. Les sources d'hétérogénéité ont été étudiées par analyse de sous‐groupes, le biais de publicatio